EP2755560B1 - Surgical instrument with fluid fillable buttress - Google Patents

Surgical instrument with fluid fillable buttress Download PDF

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Publication number
EP2755560B1
EP2755560B1 EP12762151.4A EP12762151A EP2755560B1 EP 2755560 B1 EP2755560 B1 EP 2755560B1 EP 12762151 A EP12762151 A EP 12762151A EP 2755560 B1 EP2755560 B1 EP 2755560B1
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EP
European Patent Office
Prior art keywords
buttress
anvil
adhesive
lower jaw
surgical
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Active
Application number
EP12762151.4A
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German (de)
English (en)
French (fr)
Other versions
EP2755560A1 (en
Inventor
Chad P. Boudreaux
Stephen J. Balek
Matthew D. Holcomb
Edward A. Rhad
Donald F. Wilson, Jr.
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Ethicon Endo Surgery Inc
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Ethicon Endo Surgery Inc
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Publication of EP2755560A1 publication Critical patent/EP2755560A1/en
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00491—Surgical glue applicators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07292—Reinforcements for staple line, e.g. pledgets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00491—Surgical glue applicators
    • A61B2017/00495—Surgical glue applicators for two-component glue

Definitions

  • endoscopic surgical instruments may be preferred over traditional open surgical devices since a smaller incision may reduce the post-operative recovery time and complications. Consequently, some endoscopic surgical instruments may be suitable for placement of a distal end effector at a desired surgical site through a cannula of a trocar. These distal end effectors may engage tissue in a number of ways to achieve a diagnostic or therapeutic effect (e.g., endocutter, grasper, cutter, stapler, clip applier, access device, drug/gene therapy delivery device, and energy delivery device using ultrasound, RF, laser, etc.). Endoscopic surgical instruments may include a shaft between the end effector and a handle portion, which is manipulated by the clinician.
  • Such a shaft may enable insertion to a desired depth and rotation about the longitudinal axis of the shaft, thereby facilitating positioning of the end effector within the patient. Positioning of an end effector may be further facilitated through inclusion of one or more articulation joints or features, enabling the end effector to be selectively articulated or otherwise deflected relative to the longitudinal axis of the shaft.
  • endoscopic surgical instruments include surgical staplers. Some such staplers are operable to clamp down on layers of tissue, cut through the clamped layers of tissue, and drive staples through the layers of tissue to substantially seal the severed layers of tissue together near the severed ends of the tissue layers. Merely exemplary surgical staplers are disclosed in U.S. Pat. No.
  • US 2009/0120994 describes an end effector of a surgical stapling device such as an endocutter for use on lung tissue.
  • the end effector is at the distal end of a shaft of a surgical stapling device and has a pair of moveably opposed tissue clamping members forming an anvil and a lower jaw containing a removable staple cartridge.
  • the surgical stapling device includes buttressing or matrix materials to buttress and strengthen the staple line formed in tissue, which comprise a first portion of material releasably attached to the first clamping member and a second portion of material releasably attached to the second clamping member.
  • the first portion of material contains an adhesive initiator that can initiate setting or polymerization of an adhesive on contact.
  • the second portion of material can contain a biocompatible polymer adhesive that reacts or polymerizes from contact with the adhesive initiator. Staples are positioned in rows in the removable cartridge in alignment with rows of pockets on the anvil. A knife is located between the innermost rows of staples and when the surgical device is fired, the knife travels longitudinally along the first and second clamp members, to cut both the tissue and the first and second portions of material clamped between them.
  • the second portion of material may be an open cell sponge structure filled with the fluid adhesive, and sealed by a cuttable surface that creates a fluid-filled, deformable second portion of material that can be cut or penetrated to release the adhesive.
  • the sealed second portion of material when clamped between the clamping members bulges laterally out of each side of the second clamping member and into a knife slot.
  • the bulging or ballooning is from the clamping pressure on the incompressible fluid adhesive sealed into the second portion of material.
  • the knife cuts the second portion of material it breaches the sealed surface of the second portion of material and releases the pressurized fluid adhesive sealed within. With the surface breached, the adhesive can migrate inward about the cut. The speed of the inward migration of the adhesive can be controlled by the viscosity of the fluid adhesive. The adhesive migrates over the cut in the tissue to contact the adhesive initiator in the first portion of material to create polymerized or set adhesive across the cut.
  • the polymerization process migrates from the initial initiator contact site to convert all of the adhesive into set adhesive and to prevent migration of the adhesive from the cut area.
  • the first or second portions of material could be a mesh structure or matrix.
  • the first or second portion of material could include porosities or at least one wicking feature to draw adhesive or initiator into the material. These wicking features can include a pore, a void, a weave, a bubble, an open cell, or a mesh.
  • the present invention provides an apparatus, according to claim 1, comprising:
  • FIGS. 1-6 depict an exemplary surgical stapling and severing instrument (10) that is sized for insertion, in a nonarticulated state as depicted in FIG. 1A , through a trocar cannula passageway to a surgical site in a patient for performing a surgical procedure.
  • Surgical and stapling and severing instrument (10) includes handle portion (20) connected to implement portion (22), the latter further comprising shaft (23) distally terminating in an articulating mechanism (11) and a distally attached end effector (12). Once articulation mechanism (11) and distally end effector (12) are inserted through the cannula passageway of a trocar, articulation mechanism (11) may be remotely articulated, as depicted in FIG.
  • end effector (12) may reach behind an organ or approach tissue from a desired angle or for other reasons.
  • terms such as “proximal” and “distal” are used herein with reference to a clinician gripping handle portion (20) of instrument (10).
  • end effector (12) is distal with respect to the more proximal handle portion (20).
  • spatial terms such as “vertical” and “horizontal” are used herein with respect to the drawings.
  • surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and absolute.
  • End effector (12) of the present example includes a lower jaw (16) and a pivotable anvil (18).
  • Handle portion (20) includes pistol grip (24) toward which closure trigger (26) is pivotally drawn by the clinician to cause clamping, or closing, of the anvil (18) toward lower jaw (16) of end effector (12).
  • Such closing of anvil (18) is provided through an outmost closure sleeve (32), which longitudinally translates relative to handle portion (20) in response to pivoting of closure trigger (26) relative to pistol grip (24).
  • a distal closure ring (33) of closure sleeve (32) is indirectly supported by frame (34) of implement portion (22).
  • a proximal closure tube (35) of closure sleeve (32) communicates with the distal portion (closure ring) (33).
  • Frame (34) is flexibly attached to lower jaw (16) via articulation mechanism (11), enabling articulation in a single plane.
  • Frame (34) also longitudinally slidingly supports a firing drive member (not shown) that extends through shaft (23) and communicates a firing motion from firing trigger (28) to firing bar (14).
  • Firing trigger (28) is farther outboard of closure trigger (26) and is pivotally drawn by the clinician to cause the stapling and severing of clamped tissue in end effector (12), as will be described in greater detail below.
  • release button (30) is depressed to release the tissue from end effector (12).
  • FIGS. 2-5 depict end effector (12) employing an E-beam firing bar (14) to perform a number of functions.
  • firing bar (14) includes a transversely oriented upper pin (38), a firing bar cap (44), a transversely oriented middle pin (46), and a distally presented cutting edge (48).
  • Upper pin (38) is positioned and translatable within an anvil pocket (40) of anvil (18).
  • Firing bar cap (44) slidably engages a lower surface of lower jaw (16) by having firing bar (14) extend through channel slot (45) (shown in FIG. 3B ) that is formed through lower jaw (16).
  • Middle pin (46) slidingly engages a top surface of lower jaw (16), cooperating with firing bar cap (44). Thereby, firing bar (14) affirmatively spaces end effector (12) during firing, overcoming pinching that may occur between anvil (18) and lower jaw (16) with a minimal amount of clamped tissue and overcoming staple malformation with an excessive amount of clamped tissue.
  • FIG. 2 shows firing bar (14) proximally positioned and anvil (18) pivoted to an open position, allowing an unspent staple cartridge (37) to be removably installed into a channel of lower jaw (16).
  • staple cartridge (37) of this example includes a cartridge body (70), which presents an upper deck (72) and is coupled with a lower cartridge tray (74).
  • a vertical slot (49) is formed through part of staple cartridge (37).
  • three rows of staple apertures (51) are formed through upper deck (70) on one side of vertical slot (49), with another set of three rows of staple apertures (51) being formed through upper deck (70) on the other side of vertical slot (49).
  • a wedge sled (41) and a plurality of staple drivers (43) are captured between cartridge body (70) and tray (74), with wedge sled (41) being located proximal to staple drivers (43).
  • Wedge sled (41) is movable longitudinally within staple cartridge (37); while staple drivers (43) are movable vertically within staple cartridge (37).
  • Staples (47) are also positioned within cartridge body (70), above corresponding staple drivers (43).
  • each staple (47) is driven vertically within cartridge body (70) by a staple driver (43) to drive staple (47) out through an associated staple aperture (51).
  • wedge sled (41) presents inclined cam surfaces that urge staple drivers (43) upwardly as wedge sled (41) is driven distally through staple cartridge (37).
  • firing bar (14) is advanced in engagement with anvil (18) by having upper pin (38) enter a longitudinal anvil slot (42).
  • a pusher block (80) is located at the distal end of firing bar (14), and is configured to engage wedge sled (41) such that wedge sled (41) is pushed distally by pusher block (80) as firing bar (14) is advanced distally through staple cartridge (37).
  • cutting edge (48) of firing bar (14) enters vertical slot (49) of staple cartridge (37), severing tissue clamped between staple cartridge (37) and anvil (18).
  • middle pin (46) and pusher block (80) together actuate staple cartridge (37) by entering into a firing slot within staple cartridge (37), driving wedge sled (41) into upward camming contact with staple drivers (43) that in turn drive staples (47) out through staple apertures (51) and into forming contact with staple forming pockets (53) on the inner surface of anvil (18).
  • FIG. 3B depicts firing bar (14) fully distally translated after completing severing and stapling tissue.
  • FIG. 6 shows end effector (12) having been actuated through a single stroke through tissue (90).
  • cutting edge (48) has cut through tissue (90)
  • staple drivers (43) have driven three alternating rows of staples (47) through the tissue (90) on each side of the cut line produced by cutting edge (48).
  • Staples (47) are all oriented substantially parallel to the cut line in this example, though it should be understood that staples (47) may be positioned at any suitable orientations.
  • end effector (12) is withdrawn from the trocar after the first stroke is complete, spent staple cartridge (37) is replaced with a new staple cartridge, and end effector (12) is then again inserted through the trocar to reach the stapling site for further cutting and stapling. This process may be repeated until the desired amount of cuts and staples (47) have been provided.
  • Anvil (18) may need to be closed to facilitate insertion and withdrawal through the trocar; and anvil (18) may need to be opened to facilitate replacement of staple cartridge (37).
  • cutting edge (48) may sever tissue substantially contemporaneously with staples (47) being driven through tissue during each actuation stroke.
  • cutting edge (48) just slightly lags behind driving of staples (47), such that a staple (47) is driven through the tissue just before cutting edge (48) passes through the same region of tissue, though it should be understood that this order may be reversed or that cutting edge (48) may be directly synchronized with adjacent staples.
  • FIG. 6 shows end effector (12) being actuated in two layers (92, 94) of tissue (90), it should be understood that end effector (12) may be actuated through a single layer of tissue (90) or more than two layers (92, 94) of tissue.
  • instrument (10) may be configured and operable in accordance with any of the teachings of U.S. Pat. No. 4,805,823 ; U.S. Pat. No. 5,415,334 ; U.S. Pat. No. 5,465,895 ; U.S. Pat. No. 5,597,107 ; U.S. Pat. No. 5,632,432 ; U.S. Pat. No. 5,673,840 ; U.S. Pat. No. 5,704,534 ; U.S. Pat. No. 5,814,055 ; U.S. Pat. No. 6,978,921 ; U.S. Pat. No. 7,000,818 ; U.S. Pat. No. 7,143,923 ; U.S.
  • FIGS. 7-9 show an exemplary staple cartridge (37) retainer cap (180), which may be attached to staple cartridge (37).
  • retainer cap (180) may be configured and operable in accordance with any of the teachings of U.S. Patent Application Serial No. 12/894,369 , entitled “Implantable Fastener Cartridge Comprising a Support Retainer", filed on September 30, 2010.
  • Retainer cap (180) is operable to prevent, or at least inhibit, a clinician's thumb, for example, from contacting the tips of staples (47) positioned within staple cartridge (37) when staple cartridge (37) is inserted into lower jaw (16) of end effector (12). In addition or in the alternative, it may prevent staples (47) from inadvertently falling out of the cartridge.
  • retainer cap (180) of the present example includes bottom surface (181) and top surface (182), which can provide a pushing surface for the clinician to apply a downward force thereto, for example.
  • the clinician may grab handle portion (184) of retainer cap (180), align support portion (110) of staple cartridge (37) with lower jaw (16) of end effector (12), and at least partially insert staple cartridge (37) within lower jaw (16) of end effector (12). Thereafter, the clinician can completely seat staple cartridge (37) in lower jaw (16) of end effector (12) by applying the downward force to top surface (182) of retainer cap (180) which can transmit the downward force directly to support portion (110).
  • retainer cap (180) comprises proximal supports (187) which extend downwardly and contact deck surface (111) of the support portion.
  • Retainer cap (180) further comprises distal support portion (183), which abuts nose (103).
  • the downward force can be transmitted through proximal supports (187) and/or distal support portion (183).
  • at least some of the supports may not be in contact with the top of support portion (110) before the downward force is applied to retainer cap (180); however, in some versions, retainer cap (180) can be operable to flex, or move, downwardly until retainer cap (180) touches the top of support portion (110). At such point, the downward flexure, or movement, of retainer cap (180) can be impeded, or at least substantially impeded, from flexing further.
  • retainer cap (180) can be attached to staple cartridge (37) and can be used to manipulate the position of staple cartridge (37).
  • retainer cap (180) can comprise any suitable number of gripping members which can be operable to releasably hold retainer cap (180) to support portion (110) of staple cartridge (37), for example.
  • retainer cap (180) comprises latch arms (188, 189). Latch arms (189) extend around the sides of nose (103) and engage bottom surface (109) ( FIG. 7 ) of nose (103). Similarly, latch arms (188) extend around the sides of lock projections (108) extending from support portion (110) and engage the bottom surfaces of lock projections (108).
  • latch arms (188) are operable to position retainer cap (180) over the zone or region in which the staples (47) are stored within support portion (110).
  • retainer cap (180) can be detached from staple cartridge (37).
  • any other suitable components or features may be used to provide releasable coupling of retainer cap (180) to staple cartridge (37).
  • the clinician may apply an upward lifting force to handle (184) in order to detach the distal end of retainer cap (180) from distal end (102) of staple cartridge (37).
  • latch arms (188, 189) may flex outwardly as handle (184) is lifted upwardly such that latch arms (188, 189) may flex around lock projections (108) and nose (103), respectively. Thereafter, the proximal end of retainer cap (180) may be lifted away from proximal end (101) of staple cartridge (37) and retainer cap (180) may be moved away from staple cartridge (37). With retainer cap (180) removed and with staple cartridge (37) properly seated in lower jaw (16) of end effector (12), instrument (10) may then be used in a surgical procedure.
  • a buttress (200), as shown in FIGS. 10-13 , may be used with the end effector portion of the exemplary surgical cutter shown in FIGS. 1-6 . It will be appreciated that use of buttress (200) as will be described below may facilitate quicker recovery to the surgical site where tissue has been severed and stapled by, for example, stabilizing areas where staples (47) have been applied.
  • buttress (200) may be used with retainer cap (180) described above, or alternatively, buttress (200) may be used directly with surgical severing and stapling instrument (10) described above without the use of retainer cap (180).
  • FIG. 10 shows that buttress (200) comprises a first fluid fillable member (202) or bladder and a second fluid fillable member (204) or bladder.
  • first fluid fillable member (202) may be attached to anvil (18) by an adhesive and second fluid fillable member (204) may be attached to upper deck (72) of staple cartridge (37) positioned in lower jaw (16).
  • first fluid fillable member (202) and second fluid fillable member (204) may be adhered together and adhered to anvil (18).
  • first fluid fillable member (202) and second fluid fillable member (204) may be adhered together and adhered to upper deck (72) of staple cartridge (37).
  • first fluid fillable member (202) or second fluid fillable member (204) may be used as would be apparent to one of ordinary skill in the art in view of the teachings herein.
  • FIG. 10 shows buttress (200) as it is about to be positioned between anvil (18) and lower jaw (16).
  • First fluid fillable member (202) and second fluid fillable member (204) contains a two-part liquid (220) such that when the two parts of liquid (220) come in contact with one another, as will be described below, they form a coagulant that buttresses the surgical site affected by surgical stapling and severing instrument (10) shown in FIGS. 1-6 .
  • first fluid fillable member (202) is filled with fibrin while second fluid fillable member (204) is filled with thrombin, but it should be understood that any suitable material may be used.
  • first fluid fillable member (202) and second fluid fillable member (204) may both comprise liquid (220) that may be operable to buttress a surgical site without necessarily combining with another compound.
  • any suitable number of fluid fillable members may be used as would be apparent to one of ordinary skill in the art in view of the teachings herein.
  • three or more fluid fillable members may be used, or a single fluid fillable member may be used.
  • buttress (200) may be prefilled with liquid (220) or alternatively the user or physician may fill buttress (200) with liquid (220) prior to use of surgical stapling and severing instrument (10).
  • liquid (220) may comprise a hemostatic agent, a biologically safe glue, or any other suitable adhesive material as would be apparent to one of ordinary skill in the art in view of the teachings herein.
  • buttress (200) has a generally flat, rectangular shape configured to fit in between anvil (18) and lower jaw (16). Buttress (200) has a size at least slightly larger than the width of anvil (18) or lower jaw (16). In some exemplary versions, buttress (200) may have a size significantly larger than anvil (18) or lower jaw (16). However, any suitable shape or size for buttress (200) may be used as would be apparent to one of ordinary skill in the art in view of the teachings herein. Furthermore, buttress (200) comprises a semi self-supportive structure such that buttress (200) can maintain its generally flat shape when buttress (200) is not being compressed as will be discussed below.
  • FIGS. 11A-C show a side view of buttress (200) showing how liquid (220) contained within first fluid filled portion (202) and second fluid filled portion (204) may be urged out of buttress (200).
  • buttress (200) may be placed between anvil (18) and lower jaw (16) wherein buttress (200) remains mostly flat as shown in FIG. 11A .
  • liquid (220) remains in a substantially unpressurized state.
  • buttress (200) may be preloaded to be placed between anvil (18) and lower jaw (16) such that buttress (200) adheres to staple cartridge (not shown) contained in lower jaw (16).
  • the user or physician can load buttress (200) between anvil (18) and lower jaw (16) prior to use in a surgical setting.
  • the user may remove retaining cap (180) described above in FIGS. 7-9 and replace retaining cap (180) with buttress (200) prior to clamping anvil (18) and lower jaw (16) around the tissue of the surgical site.
  • buttress (200) may be coupled to retaining cap (180), wherein retaining cap (180) is removed prior to use, leaving only buttress (200) between anvil (18) and lower jaw (16).
  • Other configurations for buttress (200) and retaining cap (180) may be used as would be apparent to one of ordinary skill in the art in view of the teachings herein.
  • FIG. 11B shows buttress (200) as it would appear when clamped by anvil (18) and lower jaw (16) resulting in a compressed region (206) and a pressurized region (208).
  • pressurized region (208) liquid (220) is forced under pressure.
  • anvil (18) and lower jaw (16) have been clamped tightly around buttress (200) prior to buttress (200) being severed or stapled.
  • phantom lines (210) show the outline of buttress (200) prior to anvil (18) and lower jaw (16) compressing buttress (200). Anvil (18) and lower jaw (16) may be clamped to sandwich buttress (200). Liquid (220) contained within buttress (200) remains pressurized in pressurized region (208). While FIGS. 11B-11C show pressurized region (208) on one side of compressed region (206), it will be appreciated that an opposite pressurized region (208) could be formed on an opposite side of compressed (206).
  • Buttress (200) comprises a generally elastic material configured to expand such that pressurized region (208) may be filled with most or all of the fluid in buttress (208) without breaking or popping under pressure. Pressurized region (208) accordingly expands beyond the region defined by phantom lines (210) to accommodate the increase in pressure and liquid of pressurized region (208).
  • cutting edge (48) discussed above in reference to FIGS. 1-6 severs tissue (90), cutting edge (48) also severs buttress (200) resulting in buttress (200) being severed as shown in FIG. 11C .
  • buttress (200) is also stapled, and buttress (200) is thus ruptured by staples (47), thereby allowing buttress (200) to begin releasing liquid (220).
  • liquid (220) is urged out of pressurized region (208) of buttress (200) and into the tissue of the surgical area thereby aiding in buttressing tissue (90) once tissue (90) is severed and stapled.
  • buttress (200) may comprise a dissolvable material such that buttress (200) may be left in tissue (90) without harming the patient.
  • buttress (200) may be removed from the surgical site once liquid (220) is released from buttress (200).
  • FIGS. 12A-B show a front cross-sectional view of buttress (200) as it is being compressed between two layers of tissue (290).
  • buttress (200) may be sandwiched between tissue (290) or in some alternative versions, buttress (200) may be pressed against either the top surface or bottom surface of tissue (290).
  • the outer surface of buttress (200) may comprise an adhesive coating to allow buttress (200) to adhere to tissue (290) prior to release of liquid (220).
  • FIG. 12B shows buttress (200) after being severed and stapled by staples (247) where pressurized region (208) containing liquid (220) urges liquid (220) through compressed region (206) into surrounding tissue (290).
  • liquid (220) may also be urged through ruptures caused by staples (247).
  • FIG. 13 shows surgical severing and stapling instrument (10) as it is being used to sever and staple tissue (90).
  • buttress (200) has been severed between anvil (18) and lower jaw (16).
  • liquid (220) has been urged from buttress (200) into the surrounding tissue (90).
  • liquid (220) may comprise any suitable liquid
  • liquid (220) comprises a coagulant, such as, for example, fibrin and thrombin.
  • Liquid (220) once urged from buttress (200) is operable to aid in coagulation of the portions of tissue (90) where staples (47) have been inserted into tissue (90).
  • FIGS. 14-16 show a buttress (300) that may be used with end effector (12) of the instrument (10) shown in FIGS. 1-6 .
  • Buttress (300) comprises a barrier portion (302) and an adhesive region (304).
  • Barrier portion (302) extends around the outer perimeter of adhesive region (304) thereby defining a first half (306) and a second half (308) of buttress (300).
  • First half (306) and second half (308) are positioned such that vertical slot (49) is positioned roughly between first half (306) and second half (308).
  • a cut line (314) extends between first half (306) and second half (308) as seen in FIG. 15 such that cutting edge (48) may cut barrier portion (302) along cut line (314).
  • cut line (314) may be omitted.
  • buttress (300) may be provided in discrete pieces on each side of vertical slot (49). Furthermore, it will be appreciated that buttress (300) may be configured as a single unit without the use of separate halves (306, 308). Similarly, while a single buttress (300) is used in the present example, it should be understood that two or more buttresses (300) may be used as would be apparent to one of ordinary skill in the art in view of the teachings herein.
  • FIG. 15 shows a cross sectional view of tissue (90) being clamped between two buttresses (300) - one buttress (300) on deck (72) of cartridge (37) and one buttress (300) on the underside of anvil (18).
  • Buttress (300) of the present example is constructed of a foam material, though it should be understood that any suitable materials may be used.
  • buttress (300) may comprise a bio-absorbable fabric.
  • Adhesive region (304) comprises an adhesive (310) held within an adhesive layer membrane (312).
  • Adhesive (310) may comprise any suitable adhesive material as would be apparent to one of ordinary skill in the art in view of the teachings herein.
  • adhesive (310) may comprise cyanoarylates, anti-microbial agents, and/or healing agents.
  • adhesive regions (304) of halves (306, 308) may comprise two or more agents such that adhesive properties are only activated when the agents are combined after halves (306, 308) are punctured.
  • Membrane (312) connected to barrier portion (302) forms a bubble configured to hold a fluid adhesive (310).
  • FIG. 15 shows membrane (312) enclosing adhesive (310).
  • Membrane (312) may be constructed of a bio-absorbable plastic and/or other bio-absorbable material. Membrane (312) may further be constructed of any suitable material as would be apparent to one of ordinary skill in the art in view of the teachings herein.
  • barrier portion (302) forms a lip around adhesive region (304) such that any fluids in adhesive region (304) are held within the perimeter defined by barrier portion (302).
  • tissue (90) that is clamped between two buttresses (300) is positioned such that adhesive regions (304) face toward tissue (90).
  • Anvil (18) is clamped against lower jaw (16) such that buttresses (300) squeeze tissue (90), thereby forming a seal between barrier portion (302) and tissue (90).
  • staples (47) pierce through membrane (312) of adhesive region (304).
  • adhesive region (304) ruptures and adhesive (310) flows out.
  • Barrier portion (302) has a cup-like shape configured to hold adhesive (310) against tissue (90) after adhesive (310) leaves adhesive region (304); while substantially preventing adhesive (310) from flowing out of buttress (300) to surrounding tissue.
  • FIG. 16 shows adhesive (310) after it has flown out from adhesive region (304) and formed an adhesive layer (316). Also in FIG. 16 , cutting edge (48) has sliced along cut line (314) severing tissue (90). It will be appreciated that staples (47) operably hold buttresses (300) pressed against tissue (90).
  • FIG. 17 shows an exemplary alternative version of buttress (400) having a plurality of adhesive regions (404) spaced apart within barrier portion (402).
  • Adhesive regions (404) comprise plastic modules operable to burst when punctured and/or when sufficiently compressed.
  • Each adhesive regions (404) has an adhesive (410) contained therein. It will be appreciated that all of the adhesive regions (404) need not necessarily contain the same adhesives (410). For example, some adhesive regions (404) may comprise one type of adhesive (410) and/or therapeutic material whereas other adhesive regions (404) may comprise a different type of adhesive (410) and/or therapeutic material. Of course, any other suitable medical fluids may be included in regions (404) in addition to or in lieu of adhesives.
  • FIG. 18 shows yet another exemplary version of buttress (500) having a foam region (504), with adhesive capsules (510) embedded and/or seeded into foam region (504).
  • Foam region (504) is contained within barrier portion (502).
  • Foam region (504) may substantially prevent adhesive capsules (510) from inadvertently leaving buttress (500) before buttress (500) is deployed at a surgical site.
  • Foam region (504) may also substantially prevent adhesive that is released from capsules (510) from escaping the surgical site after buttress (500) is deployed at the surgical site.
  • foam region (504) may substantially prevent the adhesive (510) of capsules (510) from sticking to anvil (18) and/or cartridge (18), before and/or after buttress (500) is deployed at the surgical site.
  • Adhesive capsules (510) may be constructed from any suitable method as would be apparent to one of ordinary skill in the art in view of the teachings herein.
  • FIG. 19 shows one exemplary way of making adhesive capsules (510) using a capsule forming chamber (550).
  • Chamber (550) comprises a dispenser (552) and coating medium (556). It will be appreciated that any non-reactive gas may be contained within chamber (550).
  • Dispenser (552) dispenses adhesive material (554), which falls as adhesive drops before entering coating medium (556).
  • Coating medium (556) may comprise a plastic, but any suitable material may be used as would be apparent to one of ordinary skill in the art in view of the teachings herein.
  • Adhesive material (554) contacts coating medium (556) and becomes covered with a coating, thereby forming adhesive capsules (510) at the bottom of coating medium (556). Thereafter, adhesive capsules (510) may be removed from chamber (550) and placed into foam region (504) as shown in FIG. 18 .
  • adhesive capsules (510) may be formed from any other suitable method as would be apparent to one of ordinary skill in the art in view of the teachings herein.
  • Versions of the devices described above may have application in conventional medical treatments and procedures conducted by a medical professional, as well as application in robotic-assisted medical treatments and procedures.
  • Versions of described above may be designed to be disposed of after a single use, or they can be designed to be used multiple times. Versions may, in either or both cases, be reconditioned for reuse after at least one use. Reconditioning may include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, some versions of the device may be disassembled, and any number of the particular pieces or parts of the device may be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, some versions of the device may be reassembled for subsequent use either at a reconditioning facility, or by a user immediately prior to a procedure.
  • reconditioning of a device may utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.
  • versions described herein may be sterilized before and/or after a procedure.
  • the device is placed in a closed and sealed container, such as a plastic or TYVEK bag.
  • the container and device may then be placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons.
  • the radiation may kill bacteria on the device and in the container.
  • the sterilized device may then be stored in the sterile container for later use.
  • a device may also be sterilized using any other technique known in the art, including but not limited to beta or gamma radiation, ethylene oxide, or steam.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
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  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
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EP12762151.4A 2011-09-14 2012-09-10 Surgical instrument with fluid fillable buttress Active EP2755560B1 (en)

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US13/232,401 US9999408B2 (en) 2011-09-14 2011-09-14 Surgical instrument with fluid fillable buttress
PCT/US2012/054401 WO2013039820A1 (en) 2011-09-14 2012-09-10 Surgical instrument with fluid fillable buttress

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JP (1) JP6203729B2 (ja)
CN (1) CN103917170A (ja)
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EP2755560A1 (en) 2014-07-23
CN103917170A (zh) 2014-07-09
MX358403B (es) 2018-08-16
BR112014006216A2 (pt) 2017-04-11
US9999408B2 (en) 2018-06-19
US20130062391A1 (en) 2013-03-14
RU2610199C2 (ru) 2017-02-08
JP6203729B2 (ja) 2017-09-27
RU2014114525A (ru) 2015-10-20
JP2014531240A (ja) 2014-11-27
BR112014006216B1 (pt) 2021-06-08
WO2013039820A1 (en) 2013-03-21
MX2014002976A (es) 2015-04-13

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